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Definition
of BPD — "a personality disorder"
What
is a "personality disorder"?
Clinically,
a personality disorder is an "enduring pattern of inner experience
and behavior that deviates markedly from the expectation of the
individual’s culture, is pervasive and inflexible (unlikely to
change), is stable over time, and leads to distress or impairment
in interpersonal relationships."
Other
disorders, such as clinical depression, certainly affect loved
ones. But a clinically depressed person could be depression locked
alone in a room. The very definition of a personality disorder,
on the other hand, is that it causes distress for both the person
who has the disorder and those who interact with them.
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A
short version of the definition of BPD
In
general, people with BPD feel worthless, empty, moody, needy,
depressed, and have difficulty managing their emotions. They have
trouble with boundaries--both their own and respecting others.
They are looking for that all-loving "other" who will
provide the unconditional love they cannot give themselves.
BPs
often act inconsistently, act impulsively in ways they later regret,
see other as either all good or all bad, and base their beliefs
on feelings instead of facts. Borderlines are people in pain.
BPs
commonly manage their intense pain in two ways: they act in or
act out. BPs who act in may mutilate themselves, make suicide
attempts, express self-hate, or seek outpatient or inpatient therapy.
Other
BPs manage their pain by trying to foist it on others. They blame
loved ones for all their problems, criticize, make unfair accusations,
act emotionally or physically abusive, put others in no-won situations,
and use emotional blackmail to get the love they need.
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A
longer, clinical definition of BPD used by clinicians
The
DSM-IV diagnostic criteria for borderline personality disorder
reads as follows:
A
pervasive pattern of instability of interpersonal relationships,
self-image, and affects [moods], and marked impulsivity beginning
by early adulthood and present in a variety of contexts, as indicated
by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior
covered in (5).
People with BPD feel isolated. Anxious. Terrified at the
thought of being alone. Caring, supportive people are like
friendly faces in the middle of the crowd, offering smiles,
help, and warm hugs. But the moment they do something that
suggests an imminent departure — or do anything that the BP
interprets as a signal that they’re about to leave — the BP
panics and reacts in a variety of ways, from bursting into
rage to begging the person to stay.
A
pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization
and devaluation.
People with BPD look to others to provide things they find
difficult to supply for themselves, such as self-esteem, approval,
and a sense of identity. Most of all, they are searching for
a nurturing caregiver whose never-ending love and compassion
will fill the black hole of emptiness and despair inside them.
For someone with BPD, the potential loss of a relationship
can be like facing the loss of an arm or leg — or even death.
When their fears of abandonment seem to be confirmed, they
may erupt into a rage, make accusations, sob, seek revenge,
mutilate themselves, have an affair, or do any number of destructive
things.
Identity
disturbance: markedly and persistently unstable self-image
or sense of self.
This trait refers to borderline patients’ profound and often
terrifying sense that they do not know who they are. Normally,
we experience ourselves consistently through time in different
settings and with different people. But this continuity of
self is not experienced by the person with BPD. Instead, borderline
patients are filled with contradictory images of themselves
that they cannot integrate.
Impulsivity
in at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance abuse, shoplifting, reckless driving,
binge eating). Note: Do not include suicidal or self-mutilating
behavior covered in (5).
People with BPD may also try to fill the emptiness and create
an identity for themselves through substance abuse, bingeing
and purging, indiscriminate sexual activity, shoplifting,
compulsive shopping, drinking, or substance abuse
Recurrent
suicidal behavior, gestures, or threats, or self- mutilating
behavior.
About 10 percent of all people with BPD commit suicide.
This does not include BPs who engage in risky behavior that
results in death, such as drinking and driving. Self-mutilation
is another BPD behavior that is very difficult for family
members to understand. Examples include cutting, burning,
breaking bones, head banging, needle poking, skin scratching,
pulling out hairs, and ripping off scabs — all without suicidal
intent.
Affective
instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting
a few hours and only rarely more than a few days). [Dysphoria
is the opposite of euphoria. It’s a mixture of depression,
anxiety, rage, and despair.]
Affective instability (mood changed) due to a marked reactivity
of mood (e.g., intense episodic dysphoria, irritability, or
anxiety usually lasting a few hours and only rarely more than
a few days).
Chronic
feelings of emptiness.
Patients commonly report that they feel empty inside, that
there is “nothing to me,” that they are different people depending
on whom they are with." This is very associated with
lack of identity.
Inappropriate,
intense anger or difficulty controlling anger (e.g., frequent
displays of temper, constant anger, recurrent physical fights).
Borderline rage is usually intense, unpredictable, and unaffected
by logical argument. It is like a torrential flash flood, a
sudden earthquake, or a bolt of lightning on a sunny day. And
it can disappear as quickly as it appears.
Some borderlines, however, have the opposite problem: they feel
unable to express their anger at all for fear they will lose
control if they express even the slightest anger.
Transient,
stress-related paranoid ideation or severe dissociative symptoms.
Have you ever arrived home from work without remembering how
you got there? You’ve traveled the route so many times that
your brain had its own little adventure while your eyes and
reflexes do the driving. This “out of it” feeling is a mild
type of dissociation.
People who are severely dissociating, however, feel unreal,
strange, numb, or detached. They may or may not remember exactly
what happened while they were “gone.” The degree of dissociation
can vary from the car-trip-home variety to the extreme dissociation
characterized by multiple personality disorder (this is why
it is now called “dissociative identity disorder”).
People
with BPD may have other attributes that are not part of the DSM-IV
definition, but that researchers believe are common to the disorder.
Many of these may be related to sexual or physical abuse if the
BP has experienced abuse earlier in life.
Pervasive Shame: Toxic shame is experienced as the all-pervasive
sense that a person is flawed and defective as a human being.
It is no longer an emotion that signals limits; it is a state
of being, a core identity. Toxic shame gives you a sense of
worthlessness, the feeling of being isolated, empty, and alone
in a complete sense.
Substance
abuse: BPD and substance abuse disorders often go hand in
hand. Another study reported that about 23 percent of borderline
patients had a diagnosis of substance abuse. Borderline substance
abusers are likely to abuse more than one drug (a frequent combination
is drug and alcohol abuse), are more likely to be depressed,
have more frequent suicide attempts and accidents, have less
impulse control, and seem to have more antisocial tendencies.
See http://www.actassociation.com/News/dialectical.htm.
Undefined Boundaries: People with BPD have difficulty
with personal limits — both their own and those of others.
Control Issues: Borderlines may need to feel in control
of other people because they feel so out of control with themselves.
In addition, they may be trying to make their own world more
predictable and manageable. They may choose a lifestyle where
all choices are made for them, such as the military or a cult,
or they may align themselves with abusive people who try to
control them through fear.
Lack of Object Constancy: When a person is lonely, most
of us can soothe ourselves by remembering the love that others
have for us. This ability is known as object constancy. Some
people with BPD, however, find it difficult to evoke an image
of a loved one to soothe them when they feel upset or anxious.
If that person is not physically present, they don’t exist on
an emotional level.
Interpersonal Sensitivity: Some BP’s have the astute
ability to identify and use social and nonverbal cues of others.
They can empathize well with others and often understand and
respect how others feel, and they can use these skills to “see
through others.” Some BPs may continue to use these social antennae
to uncover triggers and vulnerabilities.
Situational Competence: Some people with BPD are competent
and in control in some situations. For example, many perform
very well at work and are high achievers. Many are very intelligent,
creative, and artistic. This can be very confusing for family
members who don’t understand why the person can act so assuredly
in one situation and fall apart in another.
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